CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

Danyal Z. Khan; Hani J. Marcus; Hugo Layard Horsfall; Soham Bandyopadhyay; Benjamin E. Schroeder; Vikesh Patel; Alice O'Donnell; Shahzada Ahmed; Andrew F. Alalade; Ahmad M.S. Ali; Callum Allison; Sinan Al-Barazi; Rafid Al-Mahfoudh; Meriem Amarouche; Anuj Bahl; David Bennett; Raj Bhalla; Pragnesh Bhatt; Alexandros Boukas; Ivan Cabrilo; Annabel Chadwick; Yasir A. Chowdhury; David Choi; Simon A. Cudlip; Neil Donnelly; Neil L. Dorward; Graham Dow; Daniel M. Fountain; Joan Grieve; Anastasios Giamouriadis; Catherine Gilkes; Kanna Gnanalingham; Jane Halliday; Brendan Hanna; Caroline Hayhurst; Jonathan Hempenstall; Duncan Henderson; Kismet Hossain-Ibrahim; Theodore Hirst; Mark Hughes; Mohsen Javadpour; Alistair Jenkins; Mahmoud Kamel; Richard J. Mannion; Angelos G. Kolias; Habibullah Khan; Mohammad Saud Khan; Peter Lacy; Daniel Murray; Paresh P. Naik; Ramesh Nair; Claire Nicholson; Alex Paluzzi; Omar Pathmanaban; Dimitris Paraskevopoulos; Jonathan Pollock; Nick Phillips; Rory J. Piper; Bhaskar Ram; Iain Robertson; Elena Roman; Peter Ross; Thomas Santarius; Parag Sayal; Jonathan Shapey; Rishi Sharma; Simon Shaw; Alireza Shoakazemi; Syed Shumon; Saurabh Sinha; Georgios Solomou; Wai Cheong Soon; Simon Stapleton; Patrick Statham; Benjamin Stew; Nick Thomas; Georgios Tsermoulas; James R. Tysome; Adithya Varma; Philip Weir; Adam Williams; Mohamed Youssef

doi:10.1016/j.wneu.2020.12.171

CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

, Danyal Z. Khan, Hani J. Marcus (Lead / Corresponding author), Hugo Layard Horsfall, Soham Bandyopadhyay, Benjamin E. Schroeder, Vikesh Patel, Alice O'Donnell, Shahzada Ahmed, Andrew F. Alalade, Ahmad M.S. Ali, Callum Allison, Sinan Al-Barazi, Rafid Al-Mahfoudh, Meriem Amarouche, Anuj Bahl, David Bennett, Raj Bhalla, Pragnesh Bhatt, Alexandros BoukasIvan Cabrilo, Annabel Chadwick, Yasir A. Chowdhury, David Choi, Simon A. Cudlip, Neil Donnelly, Neil L. Dorward, Graham Dow, Daniel M. Fountain, Joan Grieve, Anastasios Giamouriadis, Catherine Gilkes, Kanna Gnanalingham, Jane Halliday, Brendan Hanna, Caroline Hayhurst, Jonathan Hempenstall, Duncan Henderson, Kismet Hossain-Ibrahim, Theodore Hirst, Mark Hughes, Mohsen Javadpour, Alistair Jenkins, Mahmoud Kamel, Richard J. Mannion, Angelos G. Kolias, Habibullah Khan, Mohammad Saud Khan, Peter Lacy, Daniel Murray, Paresh P. Naik, Ramesh Nair, Claire Nicholson, Alex Paluzzi, Omar Pathmanaban, Dimitris Paraskevopoulos, Jonathan Pollock, Nick Phillips, Rory J. Piper, Bhaskar Ram, Iain Robertson, Elena Roman, Peter Ross, Thomas Santarius, Parag Sayal, Jonathan Shapey, Rishi Sharma, Simon Shaw, Alireza Shoakazemi, Syed Shumon, Saurabh Sinha, Georgios Solomou, Wai Cheong Soon, Simon Stapleton, Patrick Statham, Benjamin Stew, Nick Thomas, Georgios Tsermoulas, James R. Tysome, Adithya Varma, Philip Weir, Adam Williams, Mohamed Youssef

Undergraduate Medicine

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Abstract

Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.

Methods: A prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.

Results: A total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.

Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.

Original language	English
Pages (from-to)	e1077-e1089
Number of pages	13
Journal	World Neurosurgery
Volume	149
Early online date	11 Jan 2021
DOIs	https://doi.org/10.1016/j.wneu.2020.12.171
Publication status	Published - May 2021

Keywords

Cerebrospinal fluid leak
Cerebrospinal fluid rhinorrhea
CSF
EEA
Endoscopic endonasal
Skull base surgery

ASJC Scopus subject areas

Surgery
Clinical Neurology

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, Khan, D. Z., Marcus, H. J., Horsfall, H. L., Bandyopadhyay, S., Schroeder, B. E., Patel, V., O'Donnell, A., Ahmed, S., Alalade, A. F., Ali, A. M. S., Allison, C., Al-Barazi, S., Al-Mahfoudh, R., Amarouche, M., Bahl, A., Bennett, D., Bhalla, R., Bhatt, P., ... Youssef, M. (2021). CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study. World Neurosurgery, 149, e1077-e1089. https://doi.org/10.1016/j.wneu.2020.12.171

@article{1caa60a032ea40adaae151cb76b19a81,

title = "CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study",

abstract = "Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.Methods: A prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.Results: A total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.",

keywords = "Cerebrospinal fluid leak, Cerebrospinal fluid rhinorrhea, CSF, EEA, Endoscopic endonasal, Skull base surgery",

author = "Khan, {Danyal Z.} and Marcus, {Hani J.} and Horsfall, {Hugo Layard} and Soham Bandyopadhyay and Schroeder, {Benjamin E.} and Vikesh Patel and Alice O'Donnell and Shahzada Ahmed and Alalade, {Andrew F.} and Ali, {Ahmad M.S.} and Callum Allison and Sinan Al-Barazi and Rafid Al-Mahfoudh and Meriem Amarouche and Anuj Bahl and David Bennett and Raj Bhalla and Pragnesh Bhatt and Alexandros Boukas and Ivan Cabrilo and Annabel Chadwick and Chowdhury, {Yasir A.} and David Choi and Cudlip, {Simon A.} and Neil Donnelly and Dorward, {Neil L.} and Graham Dow and Fountain, {Daniel M.} and Joan Grieve and Anastasios Giamouriadis and Catherine Gilkes and Kanna Gnanalingham and Jane Halliday and Brendan Hanna and Caroline Hayhurst and Jonathan Hempenstall and Duncan Henderson and Kismet Hossain-Ibrahim and Theodore Hirst and Mark Hughes and Mohsen Javadpour and Alistair Jenkins and Mahmoud Kamel and Mannion, {Richard J.} and Kolias, {Angelos G.} and Habibullah Khan and Khan, {Mohammad Saud} and Peter Lacy and Daniel Murray and Naik, {Paresh P.} and Ramesh Nair and Claire Nicholson and Alex Paluzzi and Omar Pathmanaban and Dimitris Paraskevopoulos and Jonathan Pollock and Nick Phillips and Piper, {Rory J.} and Bhaskar Ram and Iain Robertson and Elena Roman and Peter Ross and Thomas Santarius and Parag Sayal and Jonathan Shapey and Rishi Sharma and Simon Shaw and Alireza Shoakazemi and Syed Shumon and Saurabh Sinha and Georgios Solomou and Soon, {Wai Cheong} and Simon Stapleton and Patrick Statham and Benjamin Stew and Nick Thomas and Georgios Tsermoulas and Tysome, {James R.} and Adithya Varma and Philip Weir and Adam Williams and Mohamed Youssef",

note = "This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors, and represents the views of the authors alone. H.J.M., D.Z.K., and H.L.H. are supported by the Wellcome / EPSRC Centre for Interventional and Surgical Science s. H.J.M. is supported by the National Institute for Health Research (NIHR) University College London Biomedical Research Centre . R.J.P. is supported by an NIHR Academic Clinical Fellowship . D.M.F. is supported by an NIHR Academic Clinical Fellowship and Cancer Research United Kingdom Pre-Doctoral Fellowship . A.G.K. is supported by the NIHR Global Health Research Group on Neurotrauma. ",

year = "2021",

month = may,

doi = "10.1016/j.wneu.2020.12.171",

language = "English",

volume = "149",

pages = "e1077--e1089",

journal = "World Neurosurgery",

issn = "1878-8750",

publisher = "Elsevier",

}

Khan, DZ, Marcus, HJ, Horsfall, HL, Bandyopadhyay, S, Schroeder, BE, Patel, V, O'Donnell, A, Ahmed, S, Alalade, AF, Ali, AMS, Allison, C, Al-Barazi, S, Al-Mahfoudh, R, Amarouche, M, Bahl, A, Bennett, D, Bhalla, R, Bhatt, P, Boukas, A, Cabrilo, I, Chadwick, A, Chowdhury, YA, Choi, D, Cudlip, SA, Donnelly, N, Dorward, NL, Dow, G, Fountain, DM, Grieve, J, Giamouriadis, A, Gilkes, C, Gnanalingham, K, Halliday, J, Hanna, B, Hayhurst, C, Hempenstall, J, Henderson, D, Hossain-Ibrahim, K, Hirst, T, Hughes, M, Javadpour, M, Jenkins, A, Kamel, M, Mannion, RJ, Kolias, AG, Khan, H, Khan, MS, Lacy, P, Murray, D, Naik, PP, Nair, R, Nicholson, C, Paluzzi, A, Pathmanaban, O, Paraskevopoulos, D, Pollock, J, Phillips, N, Piper, RJ, Ram, B, Robertson, I, Roman, E, Ross, P, Santarius, T, Sayal, P, Shapey, J, Sharma, R, Shaw, S, Shoakazemi, A, Shumon, S, Sinha, S, Solomou, G, Soon, WC, Stapleton, S, Statham, P, Stew, B, Thomas, N, Tsermoulas, G, Tysome, JR, Varma, A, Weir, P & Williams, A & Youssef, M 2021, 'CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study', World Neurosurgery, vol. 149, pp. e1077-e1089. https://doi.org/10.1016/j.wneu.2020.12.171

TY - JOUR

T1 - CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1

T2 - Multicenter Pilot Study

AU - Khan, Danyal Z.

AU - Marcus, Hani J.

AU - Horsfall, Hugo Layard

AU - Bandyopadhyay, Soham

AU - Schroeder, Benjamin E.

AU - Patel, Vikesh

AU - O'Donnell, Alice

AU - Ahmed, Shahzada

AU - Alalade, Andrew F.

AU - Ali, Ahmad M.S.

AU - Allison, Callum

AU - Al-Barazi, Sinan

AU - Al-Mahfoudh, Rafid

AU - Amarouche, Meriem

AU - Bahl, Anuj

AU - Bennett, David

AU - Bhalla, Raj

AU - Bhatt, Pragnesh

AU - Boukas, Alexandros

AU - Cabrilo, Ivan

AU - Chadwick, Annabel

AU - Chowdhury, Yasir A.

AU - Choi, David

AU - Cudlip, Simon A.

AU - Donnelly, Neil

AU - Dorward, Neil L.

AU - Dow, Graham

AU - Fountain, Daniel M.

AU - Grieve, Joan

AU - Giamouriadis, Anastasios

AU - Gilkes, Catherine

AU - Gnanalingham, Kanna

AU - Halliday, Jane

AU - Hanna, Brendan

AU - Hayhurst, Caroline

AU - Hempenstall, Jonathan

AU - Henderson, Duncan

AU - Hossain-Ibrahim, Kismet

AU - Hirst, Theodore

AU - Hughes, Mark

AU - Javadpour, Mohsen

AU - Jenkins, Alistair

AU - Kamel, Mahmoud

AU - Mannion, Richard J.

AU - Kolias, Angelos G.

AU - Khan, Habibullah

AU - Khan, Mohammad Saud

AU - Lacy, Peter

AU - Murray, Daniel

AU - Naik, Paresh P.

AU - Nair, Ramesh

AU - Nicholson, Claire

AU - Paluzzi, Alex

AU - Pathmanaban, Omar

AU - Paraskevopoulos, Dimitris

AU - Pollock, Jonathan

AU - Phillips, Nick

AU - Piper, Rory J.

AU - Ram, Bhaskar

AU - Robertson, Iain

AU - Roman, Elena

AU - Ross, Peter

AU - Santarius, Thomas

AU - Sayal, Parag

AU - Shapey, Jonathan

AU - Sharma, Rishi

AU - Shaw, Simon

AU - Shoakazemi, Alireza

AU - Shumon, Syed

AU - Sinha, Saurabh

AU - Solomou, Georgios

AU - Soon, Wai Cheong

AU - Stapleton, Simon

AU - Statham, Patrick

AU - Stew, Benjamin

AU - Thomas, Nick

AU - Tsermoulas, Georgios

AU - Tysome, James R.

AU - Varma, Adithya

AU - Weir, Philip

AU - Williams, Adam

AU - Youssef, Mohamed

N1 - This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors, and represents the views of the authors alone. H.J.M., D.Z.K., and H.L.H. are supported by the Wellcome / EPSRC Centre for Interventional and Surgical Science s. H.J.M. is supported by the National Institute for Health Research (NIHR) University College London Biomedical Research Centre . R.J.P. is supported by an NIHR Academic Clinical Fellowship . D.M.F. is supported by an NIHR Academic Clinical Fellowship and Cancer Research United Kingdom Pre-Doctoral Fellowship . A.G.K. is supported by the NIHR Global Health Research Group on Neurotrauma.

PY - 2021/5

Y1 - 2021/5

N2 - Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.Methods: A prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.Results: A total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.

AB - Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.Methods: A prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.Results: A total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.

KW - Cerebrospinal fluid leak

KW - Cerebrospinal fluid rhinorrhea

KW - CSF

KW - EEA

KW - Endoscopic endonasal

KW - Skull base surgery

UR - http://www.scopus.com/inward/record.url?scp=85102614672&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2020.12.171

DO - 10.1016/j.wneu.2020.12.171

M3 - Article

C2 - 33444844

SN - 1878-8750

VL - 149

SP - e1077-e1089

JO - World Neurosurgery

JF - World Neurosurgery

ER -

CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

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